Bornstein J, Kaufman R H, Adam E, Adler-Storthz K
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030.
Cancer. 1988 Oct 15;62(8):1601-4. doi: 10.1002/1097-0142(19881015)62:8<1601::aid-cncr2820620824>3.0.co;2-9.
Sixteen of 46 patients (35%) with Grade 3 vulvar intraepithelial neoplasia (VIN 3) were found to have an additional site of lower genital tract squamous cell neoplasia, primarily in the cervix. The frequency of multicentricity decreased significantly with age. In addition, patients with multicentric disease (involving the vagina and/or cervix in addition to the vulva) had a significantly higher frequency of multifocal disease involving the vulva (involving more than one location on the vulva) and of recurrence than patients without multicentric disease. Human papillomavirus (HPV) DNA was detected by in situ hybridization in 81% of the women with multicentric squamous cell neoplasia. No significant difference was noticed between patients with multicentric and unicentric squamous cell neoplasia in the detection rate of papillomavirus antigen, HPV DNA, the various HPV types, herpes simplex virus Type 2 (HSV2)-related antigen, type-specific antibodies to HSV, and dual HPV and HSV2 infections. These findings suggest that HPV and HSV2, although strongly associated with VIN 3, do not influence the development pattern of squamous cell neoplasia, and that all patients with VIN 3, especially if they are younger than 50 years of age, should be evaluated periodically for additional centers of lower genital tract squamous cell neoplasia.
46例3级外阴上皮内瘤变（VIN 3）患者中，有16例（35%）被发现下生殖道鳞状细胞肿瘤另有发病部位，主要在宫颈。多中心性的发生率随年龄显著降低。此外，多中心疾病患者（除外阴外还累及阴道和/或宫颈）外阴多灶性疾病（累及外阴多个部位）及复发的发生率显著高于无多中心疾病的患者。通过原位杂交在81%的多中心鳞状细胞肿瘤女性中检测到了人乳头瘤病毒（HPV）DNA。多中心和单中心鳞状细胞肿瘤患者在乳头瘤病毒抗原、HPV DNA、各种HPV类型、2型单纯疱疹病毒（HSV2）相关抗原、HSV型特异性抗体以及HPV和HSV2双重感染的检出率方面未发现显著差异。这些发现表明，HPV和HSV2虽然与VIN 3密切相关，但并不影响鳞状细胞肿瘤的发生模式，并且所有VIN 3患者，尤其是年龄小于50岁的患者，应定期评估是否存在下生殖道鳞状细胞肿瘤的其他发病部位。
